Background Progressive hepatotoxicity is a concern in HIV-infected children exposed to long-term antiretroviral drugs and to the cytopathic effect of the HIV virus. New non-invasive procedures are being developed permitting regular assessment of the liver function.

Objective The aims of this study were to evaluate the feasibility of non-invasive hepatic investigations in HIV-1 chronically infected children, to assess the prevalence of signs of hepatotoxicity and to analyze the influence of HIV disease severity and exposure to antiretroviral therapy (ART).

Design and methods A cross-sectional prospective study conducted in HIV-1 infected children aged 8 to 18 years old. Liver function was assessed with standard serum biochemical markers, FibroTest®, ActiTest®, SteatoTest®, AshTest, NashTest®, Forns’ index, APRI, echography and transient elastography.

Results Over 60% of the 26 assessed children had signs of liver affection on at least one of the test results: 54% had elevated liver enzymes, 63%, 33%, 21% and 21% had abnormal Fibrotest®, Actitest®, Forns’ index and APRI respectively. SteatoTest®, AshTest® and NashTest® were in the normal range for most patients. Four children had liver steatosis (17%). The Fibroscan results were higher than in matched healthy children. HIV stage N and exposure to lamivudine were the main risk factors for hepatotoxicity.

Conclusions The liver is affected in a great proportion of HIV-infected children, and needs to be regularly followed with non-invasive procedures. Liver enzymes and Fibrotest® are the most sensitive tests to detect hepatotoxicity. The place of transient elastography in the management of these children needs to be further defined.